2015-2016 Application Form

THE BROOKLYN NIJINOKAKEHASHI JAPANESE CULTURAL CENTER
ブルックリン虹の架け橋日本語学校
2015-2016 年度入学申込書
Child s Full Name (English)
お名前（日本語表記）
The school he/she will be attending on weekdays in 2015-2016
Grade
Street Address
Parent/Guardian Information
Parent/Guardian 1 Full Name:
Email Address:
Home Phone:
Cell Phone:
Work Phone:
Parent/Guardian 2 Full Name:
Email Address:
Home Phone:
Cell Phone:
Work Phone:
Why do you want your child to attend our center?
お子様を当校に入学させたいと思われた理由をお書き下さい。
*Please answer either in Japanese or in English.
DOB (mm/dd/yy)
Payment Information
The application to for the 2015-2016 school year must be accompanied by a nonrefundable $40 application fee.
Please make checks payable to:
THE BROOKLYN NIJINOKAKEHASHI JAPANESE CULTURAL CENTER
Mail form and payment to:
Japanese School c/o The Brooklyn Waldorf School
11 Jefferson Avenue
Brooklyn, NY 11238
By checking here and signing below, I agree to register my child in THE BROOKLYN
NIJINOKAKEHASHI JAPANESE CULTURAL CENTER for the 2015-2016 school year, and I
agree to pay the registration fee.
Signature:
Date:

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